The term “heart failure” is a little misleading. It sounds like it’s describing a heart that has completely stopped. However, heart failure (also called “congestive heart failure”) means that the heart is failing to pump blood as well as it should. It’s often a result of other heart conditions such as high blood pressure, coronary artery disease or a past heart attack.

Unfortunately, heart failure gets worse over time. And it can come with some hard-to-ignore symptoms, including shortness of breath, fatigue, weakness, fast or irregular heartbeat, and swelling in the legs and feet. The good news is that there are medications that can help relieve symptoms and even improve your heart’s function. Digoxin is one of them. (Download a coupon for digoxin now.)

We asked Los Angeles–based pharmacist Jessica Nouhavandi, PharmD, to share her thoughts on how digoxin works and who it might benefit most. Here’s what she had to say:

Question: How does digoxin work to improve the symptoms of heart failure?

Nouhavandi: Digoxin increases the heart muscle’s ability to contract, which results in the heart pumping better and more efficiently.

Q: When would a doctor decide to prescribe digoxin?

Nouhavandi: Digoxin is not a first-line treatment for heart failure. It’s prescribed when the first-line treatment options are not enough to control the patient’s heart failure symptoms. Adding digoxin to the treatment course can provide significant relief. However, there has been a lack of evidence that it increases survival.

It’s also important to know that digoxin is not used by itself to treat heart failure. Instead, it is usually an addition to a patient’s current treatment.

Q: How do you take digoxin?

Nouhavandi: Digoxin typically comes as a tablet taken once per day. You can take it with or without food. Try to take it at the same time each day.

Alongside this medication, your doctor may prescribe a low-sodium diet and a potassium supplement. Potassium supplements can help lower the chance of a patient getting digoxin toxicity. This happens when there is too much medication in the blood. It can cause severe symptoms that can affect the heart, such as a life-threatening arrhythmia or irregular heartbeat. In this case, a patient would have to be taken to the hospital to get treated. Your doctor will monitor you closely for signs of toxicity (see below).

Q: How does your doctor decide on the right dose for you?

Nouhavandi: The optimal dose is determined by the patient’s age, weight, kidney function, clinical response, other medications and health conditions. If you are over 65, consult with your doctor about the risks and benefits of taking digoxin. The older you are, the more likely you are to experience serious side effects, especially if you are taking high doses.

Q: How long will it take to notice improvements in symptoms? And does digoxin have any side effects?

Nouhavandi: It can take up to 2 weeks to notice improvements in symptoms. Common side effects can include:

  • Nausea
  • Vomiting
  • Stomach pain
  • Dizziness
  • Headache
  • Changes in mental health (such as agitation, anxiety or confusion)

Dangerous side effects that may be symptoms of toxicity include:

  • Sudden abnormal heartbeat
  • Hallucinations
  • Confusion
  • Change in eyesight
  • Severe diarrhea or upset stomach
  • Bloody stools or vomit

Although these serious side effects are not common, if you experience any of them, it is important to get medical help right away.

Q: Are there any important medication interactions to know about?

Nouhavandi: Examples of some medications that have major interactions with digoxin are some antibiotics, blood pressure medications and antivirals. Make sure you tell your pharmacist about every medication you’re taking, including over-the-counter medications and supplements, so that they can check for possible interactions.

Q: Is there anything else you should talk to your doctor or pharmacist about before taking digoxin?

Nouhavandi: Make sure you tell your doctor or pharmacist about any allergic reactions to past medications, and about other heart problems, such as a recent heart attack. Also, ask your pharmacist about price options. Sometimes, paying out of pocket (also known as the “cash price”) for medication is much more affordable than paying your insurance copay. Generic versions will also typically cost significantly less than brand-name ones. The generic name for this medication is digoxin; 1 brand name is Lanoxin®.

You can also save on the cost of your digoxin prescription with Optum Perks. Download a coupon now.

Additional sources
Heart failure basics: Mayo Clinic and American Heart Association
Digoxin toxicity: Australian Prescriber (2016). “Management of digoxin toxicity.”
Digoxin side effects: Mayo Clinic